Mobility of Zn and Cu in Bentonites: Implications for Environmental Remediation.

The aim of this study was to evaluate the mobility of copper (Cu) and zinc (Zn) and their impact on the properties of bentonites and unfrozen water content. Limited research in this area necessitates further analysis to prevent the negative effects of metal interactions on bentonite effectiveness. Tests involved American (SWy-3, Stx-1b) and Slovak (BSvk) bentonite samples with Zn or Cu ion exchange. Sequential extraction was performed using the Community Bureau of Reference (BCR) method. Elemental content was analyzed via inductively coupled plasma optical emission spectrometry (ICP-OES). Unfrozen water content was measured using nuclear magnetic resonance (1H-NMR) and differential scanning calorimetry (DSC). Results showed a significant influence of the main cation (Zn or Cu) on ion mobility, with toxic metal concentrations increasing mobility and decreasing residual fractions. Mobile Zn fractions increased with larger particle diameters, lower clay content, and shorter interplanar spacing, while the opposite was observed for Cu. Zn likely accumulated in larger clay pores, while Cu was immobilized in the bentonite complex. The stability of Zn or Cu ions increased with higher clay content or specific surface area. Residual Zn or Cu fractions were highest in uncontaminated bentonites with higher unfrozen water content, suggesting the potential formation of concentrated solutions in sub-zero temperatures, posing a threat to the clay-water environment, especially in cold regions.

Occurrence and sources of hormones in water resources-environmental and health impact.

Within recent years, hormones have become emergent contaminants in the water environment. They easily accumulate in living organisms which in effect leads to numerous health problems (endocrine-disrupting mechanism is one of the most known toxic effects). Microbial resistance to antibiotics also became one of the emergent issues related to hormone presence. It was shown that the most common in the environment occur estrogens (E1, E2, E3, and EE2). It has been proven that large amounts of hormones are released from aquaculture as well as from wastewater treatment plants (due to the relatively low separation efficiency of conventional wastewater treatment processes). Within the article's scope, the literature review was performed. The analysis was regarding the characterization of the hormone substances present in the environment, their influence on living organisms and the environment, as well as its potential sources classification.

Parameters of Concrete Modified with Micronized Chalcedonite.

The PN-EN 197-1:2012 standard allows the use of additives as the main component above 5.0% by mass, as well as as a secondary component in an amount less than 5.0% by mass of cement. Proper selection of additives positively affects the rheological characteristics and hardened concrete parameters during longer maturity periods. Additives have already become an integral component of concrete mixes. The aim of the research is to confirm the possibility of using the tested additive in the composition of concrete mixes in an amount of 15% relative to the amount of cement, which would solve the problem of storing and utilizing waste generated during the production of broken chalcedonite aggregates. The planned laboratory tests were carried out for concrete of three classes, C30/37, C35/45, C40/50, according to the PN-EN 206+A1:2016-2 standard, with the addition of chalcedonite dust in a constant amount of 15% relative to cement, and three series without additives as control series. The additive used for concrete mixes was chalcedonite dust with a diameter below 72 µm. It is waste from a broken aggregate mine. The research program included rheological tests of fresh concrete mix, i.e., air content, consistency, bulk density, as well as parameters of hardened concrete mix-compressive strength, absorbability, and capillary uptake. Compressive strength was tested after 7, 14, 28, 56, and 90 days. The laboratory tests aimed to verify whether the addition of 15% chalcedonite dust additive would not worsen the predicted hardened concrete parameters resulting from the designed concrete classes. All three tested series, C30/37, C35/45, and C40/50, with the addition of 15% chalcedonite dust relative to the amount of cement, achieved the assumed strength classes after 28 days of maturation. Concrete mix components were correctly designed. The addition of chalcedonite dust to the concrete mix did not cause a decrease in compressive strength to the extent that the analyzed series did not meet the normative requirements for concrete classes according to the PN-EN 206+A1:2014 standard. The results of absorbability testing indicate water absorption below 5%, while the increase in sample mass in the capillary uptake test gained similar values.

Risk Analysis of Heavy Metals Migration from Sewage Sludge of Wastewater Treatment Plants.

More and more attention in sewage sludge management is being devoted to its environmental utilization. This approach is justified both from economic and environmental points of view. However, as with any method, there are certain possibilities and limitations. The goal of the natural utilization of sewage sludge is to recover the valuable agronomic properties and fertilizing potential of the sludge. The main aspect limiting the possibility of using sludge as a fertilizer is the heavy metal content. In this paper, an analysis of the risk of environmental contamination in the case of application of sewage sludge with different forms of sludge treatment was carried out. Risk indices such as Igeo and PERI, based on the comparison of total metal content in sludge and soil, as well as RAC and ERD indices, which take into account the mobility of metals in soil, were calculated. It was shown that high levels of potential risk and geoaccumulation indicators do not necessarily disqualify the use of sewage sludge, the key aspect is the form of mobility in which the heavy metals are found in the sludge, and this should be the only aspect taken into account for the possibility of their environmental use.

In-Hospital and One-Year Outcomes of Patients after Early and Late Resuscitated Cardiac Arrest Complicating Acute Myocardial Infarction-Data from a Nationwide Database.

The prognostic role of early (less than 48 h) resuscitated cardiac arrest (ErCA) complicating acute myocardial infarction (AMI) is still controversial. The present study aimed to analyse the short-term and one-year outcomes of patients after ErCA and late resuscitated cardiac arrest (LrCA) compared to patients without cardiac arrest (CA) complicating AMI. Data from the prospective nationwide Polish Registry of Acute Coronary Syndromes (PL-ACS) were used to assess patients with resuscitated cardiac arrest (rCA) after AMI. Baseline clinical characteristics and the predictors of all-cause death were assessed. The all-cause mortality rate, complications, performed procedures, and re-hospitalisations were assessed for the in-hospital period, 30 days after discharge, and 6- and 12-month follow-ups. Among 167,621 cases of AMI, CA occurred in 3564 (2.1%) patients, that is, 3100 (87%) and 464 (13%) patients with ErCA and LrCA, respectively. The mortality rates in the ErCA vs. LrCA and CA vs. non-CA groups were as follows: in-hospital: 32.1% vs. 59.1% (p < 0.0001) and 35.6% vs. 6.0% (p < 0.0001); 30-day: 2.2% vs. 3.2% (p = 0.42) and 9.9% vs. 5.2% (p < 0.0001); 6-month: 9.2% vs. 17.9% (p = 0.0001) and 12.3% vs. 21.1% (p < 0.0001); and 12-month: 12.3% vs. 21.1% (p = 0.001) and 13% vs. 7.7% (p < 0.0001), respectively. ErCA (hazard ratio (HR): 1.54, confidence interval (CI):1.28-1.89; p < 0.0001) and LrCA (HR: 2.34, CI: 1.39-3.93; p = 0.001) increased the risk of 12-month mortality. During the 12-month follow-up, patients after LrCA more frequently required hospitalisation due to heart failure compared to patients after ErCA. ErCA was related to a higher hospitalisation rate due to coronary-related causes and a higher rate of percutaneous coronary intervention. An episode of LrCA was associated with higher in-hospital and long-term mortality compared to ErCA. ErCA and LrCA were independent risk factors for one-year mortality.

Impact of diabetes mellitus on outcomes in patients with myocardial infarction according to varying degrees of left ventricular systolic dysfunction.

BACKGROUND: Diabetes mellitus (DM) is known to contribute to unfavorable short- and long-term outcomes in patients with myocardial infarction (MI). Particularly poor outcomes are associated with left ventricular systolic dysfunction after an MI. Our study aimed to compare the short- and long-term outcomes of MI in patients with DM and varying degrees of left ventricular systolic dysfunction with the corresponding outcomes in a non-diabetic control group. METHODS: This analysis focused on patients with MI registered in the Polish National Registry of Acute Coronary Syndrome between 2009 and 2011. For this analysis, diabetic patients were additionally stratified into three subgroups depending on the degree of left ventricular systolic dysfunction, as assessed during their hospitalization for MI. Subsequently, the 30-day, 12-month, and 36-month outcomes in the diabetic study subgroups were compared with those in the corresponding non- -diabetic subgroups. RESULTS: This analysis encompassed a nationwide cohort of 58 123 patients. Twelve- and 36-months mortality was greater in diabetic patients than in non-diabetic patients. The highest 36-months mortality (46.64%) was in the group of patients with DM and reduced ejection fraction (EF) <40%. Multivariate analysis showed diabetes and low EF to be independent risk factors for 36-month mortality, increasing the risk of death by 35% for diabetes and by 30% for each 5-percentage point EF decrease. Higher mortality was observed in older patients, smokers, and patients with ischemic heart disease before the index hospitalization. CONCLUSIONS: Both diabetes and reduced EF proved to be independent risk factors for increased mortality over a long-term follow-up after MI.

Three-year mortality after acute myocardial infarction in patients with different diabetic status.

Introduction: The prevalence of diabetes mellitus (DM) in patients with myocardial infarction (MI) is estimated at about 25%. Short- and long-term prognosis is worse in patients with DM and hyperglycemia compared with nondiabetics. Objectives: Our aim was to analyze the impact of DM and transient hyperglycemia on in-hospital complications and long-term outcomes in patients with MI. Patients and methods: We evaluated a prospective cohort of 58 394 patients with MI in the Polish Registry of Acute Coronary Syndromes (PL-ACS) in terms of in-hospital complications and 30-day, 12-month, and 36-month outcomes between 2009 and 2012. Results: Patients with type 1 DM (T1DM) and type 2 DM (T2DM) underwent invasive diagnostic and therapeutic procedures less frequently than those without diabetes, transient hyperglycemia, and new-onset DM (P <⁠0.001). T2DM was associated with a significantly higher risk of MI complicated by cardiogenic shock. The rates of pulmonary edema in the transient hyperglycemia group and the DM group were 2-fold higher than in the nondiabetic group (P <⁠0.001). T1DM and T2DM were associated with a significantly higher risk of death. Unadjusted 3-year all-cause death rates in patients with T1DM, T2DM, transient hyperglycemia, new-onset diabetes and those without diabetes were 26.8%, 25.6%, 18.5%, 17.9%, and 16.2%, respectively. Hazard ratios (95% CI) adjusted for age, sex, clinical characteristics, and revascularization were 1.49 (1.12­2.00), 1.20 (1.14­1.27), 0.94 (0.67­1.31), and 0.66 (0.34­1.28), respectively. Conclusions: T1DM and T2DM are associated with elevated in-hospital and long-term mortality rates after MI. Diabetics and patients with transient hyperglycemia are more likely to develop significant in-hospital complications compared with nondiabetics. No significant differences regarding acute mechanical complications were noted between populations.

Sorption of Heavy Metals by Sewage Sludge and Its Mixtures with Soil from Wastewater Treatment Plants Operating in MBR and INR Technology.

Sewage sludge is a very complex system, with solids and water. It is generated as waste from wastewater treatment. Sewage sludge is used to fertilize agricultural and forest areas and to rehabilitate devastated areas. It is a good organic fertilizer because it contains significant amounts of nutrients beneficial for plant development and humus-forming substances. The composition of sludge from municipal wastewater treatment plants is similar to soil organic matter, therefore it can be used to improve the physicochemical properties of soil, increasing its sorption capacity. Research material was collected in the Swietokrzyskie and Mazowieckie Voivodships. Sewage sludge was collected from the wastewater treatment plants in Sitkowka Nowiny (Sitkowka) and Kunow, as well as high-quality agricultural soil from Opatowiec and sandy-clay soil from Jastrzebie. Research was carried out on the sorption of heavy metals (Cd, Cr, Cu, Pb, Ni, Zn) by mixtures of sewage sludge with soil. The calculations were made for the concentrations of heavy metals in sewage sludge, soil, and sewage sludge-soil mixtures. The geoaccumulation index (Igeo) and the risk assessment code (RAC) were calculated. Increased sorption capacity was demonstrated in samples with a predominance of sewage sludge. It was shown that heavy metals from sewage sludge, after mixing with soil, changed their form from immobile to mobile.

Comparison of the Possibilities of Environmental Usage of Sewage Sludge from Treatment Plants Operating with MBR and SBR Technology.

Sewage sludge from sewage treatment plants has soil-forming and fertilising properties. However, sewage sludge cannot always be used in nature, including agriculture. One of the main reasons is the concentration of heavy metals. Sludge from wastewater treatment plants operating in MBR (membrane biological reactor) and SBR (sequential batch reactor) systems was analysed. Studies comparing the risk analysis of the natural use of sludge from MBR and SBR treatment plants were performed for the first time, due to the fact that more and more MBR plants, which are a BAT technology, are being developed in Poland, displacing the classical SBR plants. MBR technology uses a combination of activated sludge and filtration with microfiltration membranes. Wastewater treated in these reactors meets the highest quality standards, both in terms of physicochemical and microbiological aspects. This paper presents studies on the mobility of heavy metals in sewage sludge carried out using the BCR sequential extraction method. Geo-accumulation index (GAI), potential environmental risk index (ER), risk assessment code (RAC), and environmental risk determinant (ERD) were calculated. Heavy metals dominated the stable fractions in all cases. Furthermore, an increased content of copper and cadmium was observed in the MBR sludge. This fact is favourable in view of the efforts to eliminate heavy metals in the environment.

Predicting survival in out-of-hospital cardiac arrest patients undergoing targeted temperature management: The Polish Hypothermia Registry Risk Score.

BACKGROUND: Prompt reperfusion and post-resuscitation care, including targeted temperature management (TTM), improve survival in out-of-hospital cardiac arrest (OHCA) patients. To predict inhospital mortality in OHCA patients treated with TTM, the Polish Hypothermia Registry Risk Score (PHR-RS) was developed. The use of dedicated risk stratification tools may support treatment decisions. METHODS: Three hundred seventy-six OHCA patients who underwent TTM between 2012 and 2016 were retrospectively analysed and whose data were collected in the Polish Hypothermia Registry. A multivariate logistic regression model identified a set of predictors of in-hospital mortality that were used to develop a dedicated risk prediction model, which was tested for accuracy. RESULTS: The mean age of the studied population was 59.2 ± 12.9 years. 80% of patients were male, 73.8% had shockable rhythms, and mean time from cardiac arrest (CA) to cardiopulmonary resuscitation (CPR) was 7.2 ± 8.6 min. The inputs for PHR-RS were patient age and score according to the Mild Therapeutic Hypothermia (MTH) Scale. Criteria for the MTH score consisted of time from CA to CPR above 10 min, time from CA to the return of spontaneous circulation above 20 min, in-hospital CA, unwitnessed CA, and non-shockable rhythm, each counted as 1 point. The predictive value of PHR-RS was expressed as an area under the curve of 0.74. CONCLUSIONS: PHR-RS is one of the simplest and easiest models to use and enables a reliable prediction of in-hospital mortality in OHCA patients treated with TTM.

Results of targeted temperature management of patients after sudden out­of­hospital cardiac arrest: a comparison between intensive general and cardiac care units.

BACKGROUND: Targeted temperature management (TTM) is used to treat patients after sudden out­of­hospital cardiac arrest (OHCA). AIMS: The aim of the study was to compare the results of TTM between intensive general and cardiac care units (ICCUs). METHODS: The Polish Registry of Therapeutic Hypothermia obtained data on 377 patients with OHCA from 26 centers (257 and 120 patients treated at the ICCU and intensive care unit [ICU], respectively). Eligibility for TTM was based on the current inclusion criteria for therapy. Medical history as well as data on TTM and additional treatment were analyzed. The main outcomes included in­hospital survival and complications as well as neurologic assessment using the Glasgow Coma Scale (GCS) and Rankin scale. RESULTS: Both ICU and ICCU patients were mostly male (mean age, 60 years). There were no significant differences regarding the medical history, mechanism of arrhythmia responsible for OHCA, GCS score on admission, time of cardiopulmonary resuscitation activities, and the time to target temperature (33°C). Coronary angiography and the use of dual antiplatelet therapy, intra­aortic balloon pump, intravascular hypothermia, dopamine, and dobutamine were more common in ICCU patients, while ICU patients more often received norepinephrine. Pneumonia and acute renal failure were more frequent in the ICCU group. Death occurred in 17% and 20% of ICU and ICCU patients, respectively (P = 0.57). The Rankin class after 48 hours since discontinuation of sedation and at discharge was comparable between groups. CONCLUSIONS: The ICCU has become a considerable alternative to the ICU to treat OHCA patients with TTM.

Impaired hemodynamic response to tilt, handgrip and Valsalva manoeuvre in patients with takotsubo syndrome.

PURPOSE: Long-term ß-adrenolytics treatment in takotsubo syndrome (TTS) patients is based on the premise, that TTS is strongly associated with sympathetic nervous system overactivity. The aim of the study was to establish hemodynamic response to tilt, handgrip and Valsalva manoeuvre in patients with takotsubo syndrome compared to healthy subjects (CONTROL) and patients after ST Elevation Myocardial Infarction (STEMI). MATERIAL AND METHOD: Echocardiographic examination was performed at rest, ECG and continuously non-invasively measured arterial blood pressure were used for evaluation of hemodynamic responses to Valsalva manoeuvre, static handgrip (HG) followed by post-exercise ischemia, and tilt. Ten healthy women, 20 with TTS and 20 after STEMI, mean age 64 ±â€¯8.5 years, participated in the study. RESULTS: Pressor response to Valsalva manoeuvre and tilt in TTS group was diminished in comparison to CONTROL and close to that of STEMI. During HG, increase of SBP was the lowest in TTS group. Data indirectly suggest that it was due to deficient stroke volume in TTS and STEMI patients during these manoeuvres; though echocardiographic findings at rest did not reveal any significant differences between groups. CONCLUSIONS: Our data show that despite apparent resolution of the immediate effects of TTS, impaired response to cardiovascular challenge, similar to that in STEMI patients, persisted. As the manoeuvres applied mimic daily life situations, causes of impairment should be searched for and potential health risk evaluated.

Comparative Analysis of Long-Term Outcomes of Torasemide and Furosemide in Heart Failure Patients in Heart Failure Registries of the European Society of Cardiology.

PURPOSE: Current clinical recommendations do not emphasise superiority of any of diuretics, but available reports are very encouraging and suggest beneficial effects of torasemide. This study aimed to compare the effect of torasemide and furosemide on long-term outcomes and New York Heart Association (NYHA) class change in patients with chronic heart failure (HF). METHODS: Of 2019 patients enrolled in Polish parts of the heart failure registries of the European Society of Cardiology (Pilot and Long-Term), 1440 patients treated with a loop diuretic were included in the analysis. The main analysis was performed on matched cohorts of HF patients treated with furosemide and torasemide using propensity score matching. RESULTS: Torasemide was associated with a similar primary endpoint (all-cause death; 9.8% vs. 14.1%; p = 0.13) occurrence and 23.8% risk reduction of the secondary endpoint (a composite of all-cause death or hospitalisation for worsening HF; 26.4% vs. 34.7%; p = 0.04). Treatment with both torasemide and furosemide was associated with the significantly most frequent occurrence of the primary (23.8%) and secondary (59.2%) endpoints. In the matched cohort after 12 months, NYHA class was higher in the furosemide group (p = 0.04), while furosemide use was associated with a higher risk (20.0% vs. 12.9%; p = 0.03) of worsening ≥ 1 NYHA class. Torasemide use impacted positively upon the primary endpoint occurrence, especially in younger patients (aged < 65 years) and with dilated cardiomyopathy. CONCLUSIONS: Our findings contribute to the body of research on the optimal diuretic choice. Torasemide may have advantageous influence on NYHA class and long-term outcomes of HF patients, especially younger patients or those with dilated cardiomyopathy, but it needs further investigations in prospective randomised trials.

Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial.

BACKGROUND: Recent reports suggest that torasemide might be more beneficial than furosemide in patients with symptomatic heart failure (HF). The aim was to compare the effects of torasemide and furosemide on clinical outcomes in HF patients. METHODS: This study pilot consisted of data from the ongoing multicenter, randomized, unblinded endpoint phase IV TORNADO (NCT01942109) study. HF patients in New York Heart Association (NYHA) II-IV class with a stable dose of furosemide were randomized to treatment with equipotential dose of torasemide (4:1) or continuation of unchanged dose of furosemide. On enrollment and control visit (3 months after enrollment) clinical examination, 6-minute walk test (6MWT) and assessment of fluid retention by ZOE Fluid Status Monitor were performed. The primary endpoint was a composite of improvement of NYHA class, improvement of at least 50 m during 6MWT and decrease in fluid retention of at least 0.5 W after 3-months follow-up. RESULTS: The study group included 40 patients (median age 66 years; 77.5% male). During follow-up 7 patients were hospitalized for HF worsening (3 in torasemide and 4 in furosemide-treated patients). The primary endpoint reached 15 (94%) and 14 (58%) patients on torasemide and furosemide, respectively (p = 0.03). CONCLUSIONS: In HF patients treated with torasemide fluid overload and symptoms improved more than in the furosemide group. This positive effect occurred already within 3-month observation.